Tag Archives: Neurology

Parkinson’s Disease Clinic and Week 2

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Spending a day with neurologists examining Parkinson’s patients at UBC clinic was an interesting day. Learning about the disease sitting in a class vs. actually seeing the patients in person and listening to their stories is a totally different experience as it allows you to apply the theoretical knowledge gained in class. The two neurologists I followed were super helpful! I was curious about different neurology examinations and ways to adjust medications. They helped me answer questions and put things into perspective.
I learnt about different uses of Botox (a purified neurotoxin complex protein produced from the bacterium Clostridium botulinum). For example I did not know that it is used for dystonia. Patients get a repeat dose every 3-4 months. It takes 48 hrs for onset and reaches peak in about 2 weeks.
One of the patients received it for central dystonia and the other one got it for Meige’s syndrome.
The time spent at the clinic reinforced the fact that the timing of medication is extremely important in Parkinson’s disease patients. Therefore, when they are admitted to the hospital, the pharmacist should learn the dose times and make sure the patient gets it at the same time in hospital as well.

Other tid-bits:
Domperidone is used for both nausea and orthostatic hypotension (usually given half an hour before the levodopa dose)
Dopamine antagonists
– Inhibit the vasodilating and natriuretic effect of dopamine and increase noradrenaline release by blocking receptors for dopamine which exhibits inhibitory control of noradrenaline.
– EPS and tardive dyskinesia limits their long-term use.
Some patients experience Sinemet addiction wanting more even when not required??
Donepezil can worsen confusion in some cases ( very rare)

Some research to do:
Mirtazapine’s use for tremor??
Rasagiline has been shown to have neuroprotective effect??
Donepezil for orthostatic hypotension??

Topics discussed:
Parkinson’s Disease and Multiple Sclerosis
Attended Neuro Grand Rounds

Neurology Week 3

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Case Presentation Neurology
Friday: Warfarin and Dabigatran teaching
Goals for last week:
See more patients: Work up at least 2 new patients every day
Choose patients with other neurologic conditions besides Stroke/TIA
Speak slowly and louder with patients (esp. elderly)

Tuesday: Multiple Sclerosis Clinic at Burnaby Hospital
Thursday: Case Presentation
Topics Covered:
Neuropathic Pain

Stroke Clinic

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Attended Stroke Clinic on Thursday at ARRH with Dr.Constantino at Abottsford Hospital.

It was a great experience as I saw the neurologist conduct different examinations to find neurologic deficits in terms of sensory and motor symptoms.
One of the patients had been on combination of ASA + clopidogrel for few months after a stroke even though evidence shows that there is no evidence of using the combination therapy beyond a month (FASTER trial). Therefore, clopidogrel was discontinued.

I also realized that non-drug measures play a huge role in preventing stroke especially smoking cessation and diet.

The visit to the clinic provided me with an insight of what happens after stroke patients leave hospital and how they are managed as out-patients.